Min-Young Park

Polyaniline and multi-walled carbon nanotube composite electrode for rechargeable battery

The multi-walled carbon nanotube was introduced into the polymer matrix (PANI) to improve the electric conductivity as well as mechanical properties of the original polymer matrix. PANI/multi-walled carbon nanotube (MWCNT) composites were synthesized via ex-situ and in-situ polymerization to improve their electrical property. And the DC conductivities of PANI/MWCNT according to content and diameter of MWCNT were measured by four-point probe. The highest electric conductivity of PANI/MWCNT composite is 20 S/cm when 0.3% (mass fraction) MWCNTs with 10 nm in diameter and 15 μm in length are added in composite.

Pirfenidone-induced photo-allergic reaction in a patient with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic, fatal lung disease associated with inevitable loss of lung function. The prognosis is poor, with a median survival of 2.5–3.5 years after diagnosis (1). Pirfenidone is a novel agent for the treatment of IPF that has anti-fibrotic, anti-inflammatory and antioxidant effects. It may prevent the progression of lung fibrosis through inhibition of fibroblast (2). However, pirfenidone has some adverse effects, which occur in 28% to 53% of patients. Skin reactions were the most commonly reported adverse effects and implicated as the major reason for discontinuation or dose reduction of pirfenidone. Among such effects, photosensitivity has been reported infrequently in a few previously published studies (3). The patient was a 74-year-old fisherman who presented with itchy erythematous patches on the face, neck and dorsal aspects of both the hands since 1 month (Fig. 1a–d). He had been diagnosed with IPF five months before and received pirfenidone (Pirespa) therapy as a regimen with gradually increasing dose until nine capsules of 200 mg per day (total: 1800 mg/day) with good tolerability. After 3 months of treatment, he developed mild itchy erythema on the face, which showed rapid exacerbation. A skin biopsy was performed for the facial lesions, and the histopathological findings showed epidermal spongiosis with lichenoid reaction and basophilic degeneration of upper dermis. Apoptotic keratinocytes were not observed (Fig. 2a, b). A minimal erythema dose (MED) for UVA was determined using UV 801 KL-1 , (Waldmann Medizintechnik Corporation, Villingen-Schwenningen, Germany) in a normal range (70 J/cm, Normal 60–100 J/cm). Two equal sets of allergens (pirfenidone) were prepared with 1% petroleum in 8 mm Finn Chambers for photo-patch testing and applied on symmetrical areas of the back (Fig. 2c). 1 and 3 days after irradiation (10 J/cm of UVA), the irradiated site revealed positive reaction to pirfenidone (Fig. 2d, e). It revealed some itchy papules on irradiated side and tent to mild increase in intensity with in 72 h after irradiation. Based on clinical features (late onset), photo-patch testing (crescendo pattern) and histopathological findings (no apoptotic keratinocyte), present case was diagnosed as a photo-allergic rather than phototoxic reaction to pirfenidone. Subsequently, the patient received oral methylprednisolone as 16 mg/day for 2 weeks, and the dose was gradually tapered off along with additional therapy including topical corticosteroid and oral

Localized argyria: troublesome side-effect of acupuncture

events of PD-1 immunotherapy are being increasingly reported and characterized. Since our initial publication, additional cases of eruptive KAs have been reported, supporting its status as an associated adverse event. It is encouraging to see these reports so that we can better characterize the adverse event profile and gain insight into pathogenesis. It is unclear exactly why KAs paradoxically erupt secondary to a medication used to treat squamous cell carcinomas (SCCs) of the lung and head/neck. It is further confusing in the light of a recent publication reporting very similar PD-L1 expression profiles between KAs and cutaneous SCCs. Nevertheless, the eruption of KAs in PD-1 immunotherapy may prove fortuitous by providing new insight into their unique biology. Although KAs may simply represent a well-differentiated variant of SCC, many consider them a distinct entity – a notion supported on the molecular level. We know PD-1 inhibitors enhance antitumour activity by blocking the immune downregulation that occurs when PD-1 on T cells binds its ligands, often strategically overexpressed on malignant tumour cells. However, antitumour activity is not the only T-cell function ‘unchecked’. Tcell receptor signalling, cytokine production, lymphocyte motility and metabolic programming are all ‘unchecked’ by inhibiting PD-1. Perhaps then KAs are closer related to a reactive proliferation akin to exuberant squamous metaplasia, and a pro-inflammatory cytokine milieu injures predisposed keratinocytes in a way that incites a reactive proliferation that outpaces any enhanced antitumour activity. In the same vein, increased cytokine production (e.g., IL-2, IL-4) could tip a precarious inflammatory balance towards Th1 (lichenoid dermatitis, vitiligo) or Th2 (antibody-related disease) pathways. Further investigation into these immune-related adverse events is certainly needed and might include the immunohistochemical characterization of the inflammatory infiltrate before, during and after immunotherapy. Such information may provide further insight into pathogenesis as well as possible immunohistochemical methods for monitoring treatment efficacy and progress.

Refractory acrodermatitis continua of Hallopeau successfully treated with oral alitretinoin

myosin light chain or sarcoplasmic calcium-binding protein. The 36–38-kDa bands were consistent with the molecular weight of tropomyosin which is the major shrimp antigen, although specific IgE to tropomyosin (Pen m1; ImmunoCAP ) was undetectable (anti-tropomyosin IgE, <0.1 UA/mL). However, FDEIA due to shrimp associated with specific IgE to the 43-kDa band is rare. In 2014, Gamez et al. identified new allergens from Solenocera melantho shrimp, including a 43-kDa protein. A total of 60 patients with seafood allergy were studied, and the allergenic profiles to shrimp were analyzed using IgE immunoblotting. Some of the most frequently recognized protein bands were analyzed using mass spectrometry. It was reported that fructose 1,6-bisphosphate aldolase (FBPA), a 43kDa protein, is a new shrimp allergen. Fructose 1,6-bisphosphate aldolase from S. melantho shrimp is the first reported crustacean FBPA with an IgEbinding property. FBPA has previously been reported as an allergen in fish, Forcipomyia taiwana, Anisakis and fungi, and recently in Manihot esculenta. This protein is an important glycolytic enzyme. Thus, there is a possibility that the major allergen of FDEIA due to shrimp is the 43-kDa new antigen because of its high intensity band of immunoblotting and report by Gamez et al. This report suggests that the 43-kDa antigen is a new antigenic candidate in FDEIA due to shrimp; nevertheless, tropomyosin is a major antigen in general shrimp allergy. CONFLICT OF INTEREST: None declared.

Improvement of depressive symptoms in patients with moderate to severe psoriasis treated with ustekinumab: an open label trial validated using Beck Depression Inventory, Hamilton Depression Rating scale measures, and 18Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)

Abstract Background: Psoriasis is a chronic skin disease associated with psychiatric co-morbidities, especially depression. Early detection of psychological vulnerability in patients with psoriasis seems to be of great clinical importance and significantly impacts the quality of life of the patients. Objectives: We sought to clarify the association between psoriasis and depressive symptoms in patients with moderate-to-severe psoriasis, and to determine the risk factors for depressive symptoms and analyze the effect of ustekinumab on the symptoms. We also aimed to evaluate the changes in glucose metabolism using 18fluorodeoxyglucose (FDG) positron emission tomography (FDG-PET). Methods: Fifteen patients with moderate-to-severe psoriasis scheduled to be treated with ustekinumab were enrolled. At baseline and after achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI) score (PASI75), all patients underwent a psychiatric interview and FDG-PET. Fifteen healthy volunteers were enrolled for comparison. Results: Patients with moderate-to-severe psoriasis were more depressed than those in the control group were (p < .05). The severity of psoriasis at baseline did not correlate with the depression symptoms. Treatment with ustekinumab significantly reduced the depressive symptoms, as verified using Beck Depression Inventory and Hamilton Depression Rating Scale psychiatric interviews (p < .05). However, FDG-PET of the brain showed no significant difference before and after PASI75 achievement using ustekinumab injection. Conclusions: Patients with moderate-to-severe psoriasis are at an increased risk for depressive symptoms, and treatment with ustekinumab may be beneficial. FDG-PET does not reflect the changes in depressive symptoms in such patients.

Refractory sclerosing panniculitis successfully treated with cyclosporin

lary edema in the dermis (Fig. 1c, d) without abscess, vasculitides or tumor cells. The differential diagnosis included bacterial, fungal and mycobacterial infection, acne fulminans, malignant tumor, cutaneous lymphoma, Sweet’s syndrome and PG. We excluded infection based on the culture test. The eruption was not associated with systemic symptoms, such as fluctuating fever and painful and swollen joints, excluding acne fulminans. We also excluded malignant tumor and cutaneous lymphoma based on the histopathological findings. Typical Sweet’s syndrome was excluded because neither fever nor upper respiratory tract infection preceded development of the skin lesion, although histopathology are rather in favor of Sweet’s syndrome. Therefore, the patient was finally diagnosed as having PG. The treatment was changed to 40 mg/day prednisolone and 0.125 mg/day colchicine. The lesion decreased in size, no new lesions appeared and the patient’s vision improved 1 week later. Pyoderma gangrenosum most commonly occurs with an abrupt onset in the form of blisters, pustules, papules or hemorrhagic papules that rapidly progress into an ulcer, which may leave a scar. Because histopathology also shows the character of Sweet’s syndrome, our case may be categorized as pustular PG/Sweet-like neutrophilic dermatosis which is one of the prototypic forms of PG. PG is often associated with conditions, such as inflammatory bowel disease, leukemia, MDS and rheumatoid arthritis. Brinus et al. reported that only 7.8% of PG develops on the face and neck, whereas 77.7% occurs on the leg. We found 40 cases of facial PG in the English-language and Japanese published work, analyzing them in terms of underlying disease. Patients without any underlying diseases accounted for 32.5% of facial PG cases, in contrast to 20.3% of PG cases at all sites. Thus, when underlying disease is present, facial PG is less likely to occur than PG at other sites. Therefore, we should consider PG as a differential diagnosis when painful nodules and/or ulcers are present on the face even in the absence of underlying disease. Because the face is important aesthetically, prompt diagnosis and appropriate treatment are essential.

Infratemporal fossa abscess of dental origin: a rare, severe and misdiagnosed infection

Infratemporal fossa abscess (IFA) can be misdiagnosed due to its rarity. The primary cause of IFA is an odontogenic infection originating from the mandibular molars. A 76-year-old man presented with a protruding mass of 3×4 cm in the left preauricular area, which was first noticed by the patient three months prior.(Fig. 1. A, 1. B) Symptoms, To the Editor, The infratemporal fossa (ITF) is an anatomic space of great importance. It contains major neurovascular structures and communicates with the orbit and middle cranial fossa. Therefore, an infection in the infratemporal space is a potentially lethal condition. LETTER TO THE EDITOR

Pigmentary mosaicism with trisomy 7.

Dear Editor, Hypomelanosis of Ito (HI) is a sporadic pigmentary anomaly along the Blaschko lines, characterized by linear and whorled hypopigmentation. In 1992, Ruiz-Maldonado et al. published a suggestion for diagnostic criteria of HI based on vast clinical experience. Nevertheless, it is important to point out that HI is not a specific diagnosis, but may occur owing to several different chromosomal abnormalities. This group of disorders is better termed “pigmentary mosaicism” (PM). A 21-month-old boy was initially examined because of hypopigmentation that appeared as linear and whorled streaks along the Blaschko lines (Fig. 1a,b). He was delivered at 41 weeks’ gestation with a birthweight of 2880 g. The pedigree showed no evidence of similar abnormalities. Early infant development was normal. By Ruiz-Maldonado’s criteria, he was diagnosed as presumptive HI. Cytogenetic analysis of peripheral blood revealed normal standard karyotype (46, XY). Microarray comparative genomic hybridization (aCGH) did not detect any microdeletion or duplication. Histological examination of the hypopigmented area revealed mildly decreased melanin pigments in the basal layer compared with normal skin (Fig. 1c–f). Karyotype analysis of fibroblast cultures from the hypopigmented lesion revealed a trisomy 7 cell line, 47, XY, +7, and that from normal skin showed 46, XY (Fig. 1g,h). Thus, a diagnosis of PM with trisomy 7 was made, and on recent examination at age 2.5 years, no extracutaneous abnormalities were observed. Although all patients with PM have been hypothesized to have underlying mosaicism, chromosomal mosaicism is found in only 20–30% of the patients. It is caused not only by submicroscopic genetic abnormality, but possibly also because conventional karyotyping of blood lymphocytes or skin fibroblasts cannot always show chromosomal abnormalities. Blood is a conventional specimen for karyotyping. However, it is recommended to karyotype skin fibroblasts as lymphocytes may not demonstrate the abnormal cell line. Such discordance between karyotypes of blood and skin is rare but has been reported. Skin pigmentation is closely related to epidermal–dermal interaction. Although pigmentation is primarily related to the melanocytes, the surrounding keratinocytes and extracellular matrix proteins and fibroblasts in the underlying dermal compartments actively contribute to cutaneous homeostasis. Thus, we suppose that skin biopsy is the best way to obtain an appropriate specimen for karyotyping, and it is better to check both fibroblasts and keratinocytes. Mosaic trisomy 7 is a rare condition. Several pigmentary genes on chromosome 7 were identified (EGFR, GPNMB, HGF, EPHA1, GPDS1) that may affect abnormal pigmentation in HI. Another trisomy mosaicism associated with HI has also been reported. No effective treatment for pigmentary mosaicism has been established; the hypopigmented macules persist throughout life, and the prognosis is influenced by the associated extracutaneous findings such as renal malformation, facial dysmorphism and growth retardation. Ours is the only case of trying to find any submicroscopic abnormalities in blood by using aCGH. However, as in our case, mosaic trisomy 7 has not yet been demonstrated in peripheral blood. Therefore, skin biopsy is crucial for karyotyping and should be performed promptly for chromosome analysis.

Dermoscopic Finding in Pigmented Purpuric Lichenoid Dermatosis of Gougerot-Blum: A Useful Tool for Clinical Diagnosis

Vol. 30, No. 2, 2018 245 Received August 22, 2016, Revised November 29, 2016, Accepted for publication April 11, 2017 Corresponding author: Byung-Soo Kim, Department of Dermatology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: 82-51-240-7338, Fax: 82-51-245-9467, E-mail: dockbs@pusan.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright